Health Notes: Cervical Cancer Awareness

With Cervical Health Awareness Month upon us come January, the topic is important, especially in light of the sobering statistics.

“Incidence of cervical cancer has not changed in the last 10 years, with 12,820 new cases estimated in 2017, accounting for 4,210 deaths,” says Dr. Lindsay Kuroki, a Washington University gynecologic oncologist, quoting figures from the American Cancer Society.

The U.S. Preventive Services Task Force (USPSTF) recommends Pap tests to screen for cervical cancer every three years in women ages 21 to 29 years, and either Pap test screening every three years alone or every five years with human papillomavirus (HPV) testing in women ages 30 to 65 years. Yet many women still have a Pap test every year as part of an annual well-woman exam. What are your thoughts and recommendations regarding Pap test frequency?

The fundamental goal of cervical cancer screening is to prevent morbidity and mortality from cervical cancer. Most Pap abnormalities are related to HPV infections that go away when recognized by women’s immune systems. There’s no benefit to identifying these. Only persistent infections cause cancer. The HPV test is better at detecting these changes so it doesn’t need to be done as often.

Many women and providers want to be safe, so they screen too often. Over-screening leads to harms, such as anxiety, cervical injury and disrupted relationships after diagnosis of a sexually transmitted infection. The USPSTF recommendations are a good balance between benefits and harms.

There continues to be controversy surrounding the HPV vaccine, and some parents who are concerned about side effects decline this vaccine for their adolescent children. What would you advise these parents regarding the benefits versus risks of the vaccine?

The Centers for Disease Control and Prevention and the Food and Drug Administration have reviewed the safety information for the prophylactic HPV vaccines and have determined that they are safe and nearly 99 percent effective if administered before first sex, since almost everyone contracts HPV. Serious side effects are rare and similar to other vaccines. Commonly reported symptoms include injection-site reactions such as brief soreness, redness or swelling, dizziness, fainting, nausea, and headache.

Like all vaccines, the HPV vaccine is monitored on an ongoing basis to make sure it remains safe and effective. As a gynecologic oncologist, I advise parents that the HPV vaccine is a rare opportunity to protect their child against HPV-related cancers. HPV causes 30,700 cancers in men and women, and the HPV vaccination can prevent most of the cancers – about 28,000 – from occurring.

For women who are diagnosed with cervical cancer, new treatments have been introduced. What are the most effective new treatments, and how much have they affected cervical cancer survival?

New treatments are exciting, but prevention through vaccination and screening remains the best strategy. The first targeted biologic agent, bevacizumab, plus chemotherapy, helps women with advanced cervical cancer live four months longer. However, considerations of adverse effects, cost and duration of therapy are important to discuss. More recently, immunotherapy research holds promise as a new cervical cancer therapy option.

Are there signs of cervical cancer that women should recognize and see a physician about?

Unfortunately, women with early cervical cancers and pre-cancers typically have no symptoms, which is why adherence to cervical cancer screening is so important. However, those who present with more advanced disease may experience abnormal vaginal bleeding or discharge, odor, pelvic pain, painful intercourse, lower back pain, unintentional weight loss, or difficulty urinating or having bowel movements.

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